Then I met Chris Morgan (not his real name). My first encounter with Chris, a 25-year-old with epidermolysis bullosa, was in April, when he was admitted to the general medicine service for refractory nausea and vomiting. As with all patients I admit to the hospital, before meeting Chris, I spent some time performing a “chart biopsy” on the computer, reviewing his most recent clinic notes and hospital discharge summaries. Chris had what one dermatologist called “end-stage” epidermolysis bullosa, an inherited disorder that manifests itself as blistering or erosion of the skin and, in some cases, the epithelial lining of other organs. Over the past year, he had been hospitalized four times, for a total of 15 weeks, for a complicated urinary tract infection (he had bilateral nephrostomy tubes and a suprapubic catheter due to the erosion of his urogenital system), a central line infection (he had a Hickman catheter for delivery of both his medications and his parenteral nutrition), hypertension-associated seizures, and another urinary tract infection. In his last clinic note, written just before sending Chris to the emergency department for admission, Chris’ primary care physician wrote that he suspected another urinary tract or line infection as the root of Chris' nausea and vomiting. He also wrote that given Chris' painful medical course over the past year, this upcoming hospitalization might be an appropriate time to address transitioning his care to comfort measures only.